Vertigo?

[Tethys]

I used to have problems on decent with equalizing my ears (I have sinus problems)... I have fixed this by taking Sudafed -- it worked wonders. However, now I have problems equalizing on ascent, instead.
The problem with me is that I get vertigo if I decrease my depth during a dive.... whether to go over some coral, or up a slope or wall...I have to go extremely gradually or I get really dizzy, have to stop and close my eyes and wait for it to pass. Also, the last two dives I've made I had pain in my ears when ascending and had to take a lot of time to ascend.
I've read all the articles on how to equalize during decent, but there's nothing (that I could find) on the other way around. Any ideas?

Tethys

 

[John Reinertson]

Clearing in either direction is affected by the anatomy of your individual Eustachian tubes and by the degree of swelling of the mucous membranes in the vicinity of the Eustachian tubes.
As I understand it, you have some trouble clearing both ways, currently much worse on ascent.

You can't change the anatomy of the Eustachian tube, but you can affect the degree of congestion or swelling. Sudafed constricts the blood vessels in this area and shrinks swelling somewhat in that way. These are tissues with a large blood vessel supply. It is a useful medication but not the only one.

Cortisone sprays or oral prednisone tablets reduce the inflammatory response in people with allergies or some types of infections, and thereby improve equalization for many divers.

Antihistamine medications block one step in the allergy-inflammation-swelling cycle and reduce local swelling in that way.

All of these are valuable in some people, all have some side effects in some people, and each is useless in some people.

Individual exam and individualized therapy is the route to go for someone with problems worse than the occasional stuffy nose.

Your vertigo with even slight changes in pressure suggest the possibility of a more serious condition in the inner ear and needs to be evaluated carefully by an ENT or a doctor intimately familiar with ear disease.

When you visit your doc, don't be afraid to bring up therapeutic options and discuss with him or her the possible causes of your symptoms and side effects of the medicines.
It's often particularly important to explain to a non-diving doctor the importance of avoiding drowsiness. Most docs are familiar with Eustachian tube function and how to improve it, but may not be aware of the extent to which alertness is crucial in divers.

Review some of DAN's online info about ear problems and Doc Campbell's web site (scubadoc.com, if memory serves me correctly) before you visit your doc.

If you don't get an interested and intelligent response from the doc, check with DAN for diving doc recommendations.

Keep the bubbles in the water and not in your eardrums,

John

 

[Tethys]

So, in other words, there's no easy solution? Heh, oh well. What I have to try to decide is if I'd rather have problems going down or up, because the problems ascending didn't start occurring until I started treating the problems decending.
I think I will go see a doctor at some point (when I'm not on this island anymore, because there aren't any good ones here), simply because it's annoying more than anything else. If the problem gets worse, however, I'll seek one out as soon as I can. Until then, I'll just keep going really slow.
Thanks for your help!

Tethys

 

[Tethys]

Well, I went diving today, and the problem definately got a lot worse. Sigh...
It was my first dive in my AOW course, and it was the deep dive. We went down to about 84 ft, and near the end of the dive, we were going up a slope, and about 30 ft. I got some vertigo and my right ear started hurting badly. It took like what seemed forever for me to surface, because I could only move maybe a foot at a time before I had to stop and wait. The pain nearly made me want to cry. My instructer was concerned that he may have to fill out an incident report for me. I did do my second dive, after an hour surface inverval, but I didn't go any deeper than 30 ft, and I didn't have any problems this time.
What's really weird is that now, above my ear, right behind my temple my head feels bruised and squishy...like there's water or something under the skin...very weird.
Anyway....I'm going to see a doctor, if there is an ear doctor on this island. And I'm going to stop taking my decongestant before dives, because I'd rather have trouble going down than not be able to get back up.

 

[scubadoc]

Sorry that you are having so much trouble! Clearing problems are the most frequently seen (and limiting)of all of the maladies associated with scuba. Ear and sinus clearing problems are the subject of most of the letters that we get. Occurrence in an experienced diver usually indicates some change in the status of their nasopharynx, either intrinsic or extrinsic. Chronic difficulty also often indicates 'rhinitis medicamentosa' or the nasal lining is chronically swollen from rebound congestion due to the development of rhinitis due to nasal sprays, allergies or air pollutants. (Recent moves, recent medications, both oral and nasal).

Oral medications can be the culprit, such as alpha blockers taken for prostate difficulties, anti-hypertensives and many other personal reactions to drugs.

Intranasal polyps are a frequent offender, as well as other growths near and around the openings to the Eustachian tubes. There is a doctor in ther UK who removes bony protuberances around the openings to the ETs and who claims an 80% improvement rate.

Before you give up on your diving, have a good examination by a competent ENT doctor who has diving medical knowledge. This may be the hard part, finding the right person.

Tips on finding the right person:
1. Call the nearest recompression chamber and get a referral to their ENT consultant.
2. Call DAN for a referral +1-919-684-2948
3. Check our web page for your state or location
http://scuba-doc.com/listchmbr.htm
4. Call several ENT offices and ask if the doctor dives.

If your exam checks out OK, then you may need to reexamine your clearing technique(s). Attached is an article covering the various methods for clearing.

The middle ear barotrauma that you cause with your difficult clearing on descent results in damage to the inner lining of the middle ear, with serum and blood accumulation. This results in extreme difficulty ascending with more pain, infection, decreased hearing and occasionally balance problems that can last as long as it takes for the ear to drain.

Thanks to Dr. Reinertson for his referral to my web site. The URL is http://scuba-doc.com/.

Information about the ear is at http://www.scuba-doc.com/entprobs.html

Best regards for safe diving!
Ern Campbell, MD
Diving Medicine Online
http://scuba-doc.com/

 

[Tethys]

Hey, sorry it took me so long to get back to this. I've been resting up and haven't done any diving since the last time, waiting until I was absolutely certian that my ear was better.
I told my mom about what happened and she wondered if it could be caused by the large number of ear infections I had as a child. Is it possible that there is scar tissue or something blocking my eustatian tubes?
My dive instructor gave me some good advice on clearing during ascent that I'm going to try out the next time we go diving and I'll be seeing a doctor as soon as I'm able to leave the island.
Thanks so much for your help, I really appreciate it.

Tethys